Preventive Care Survey For Puppies

Preventive Care Survey For Puppies

Please provide your details below and we will get back to you shortly.

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If puppy’s is

Puppy’s Name

Your Name *

First

Last

Email *

Phone Number *

Is your puppy microchipped?

• Yes
• No
• Unsure

Please tell us about your puppy’s diet *

Please tell us about any treats, dental chews, and human food your puppy receives *

What is your puppy’s date of birth?

If birthday is unknown, please give approximate age.

When and where was your puppy acquired?

Has your puppy started heartworm/intestinal worm prevention? *

• Interceptor Plus
• Heartguard
• Proheart6
• None
• Other

When was your puppy’s last dose given? *

Has your puppy started flea & tick prevention? *

• Bravecto
• Nexgard
• Credelio
• None
• Other

When was your puppy’s last dose given? *

Please tell us about any other prescription, OTC medications, &/or supplements your pet is taking, including current dose and frequency.

Please check any of the following that apply *

• My puppy lives with other animals
• My puppy lives with children
• My puppy visits dog parks
• My puppy goes to grooming/boarding facilities

If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.

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